Piriformis syndrome is sciatic nerve entrapment at the level of the ischial tuberosity (The sit bones). The medical publication STATPEARLS at the National Institutes of Health describes the symptoms as: “report(ed) pain in the gluteal region that is characterized as shooting, burning, or aching down the back of the leg. In addition, numbness in the buttocks and tingling sensations along the distribution of the sciatic nerve is not uncommon.” (1)
Treatment options
Below we will explore research on treatment options for Piriformis syndrome. Generally doctors will follow an anti-inflammatory path with NSAIDs and possibly steroid anti-inflammatories. When these are not responsive, other options, like those below will be explored including surgery.
A February 2021 paper (2) describes current treatment options:
“Clinicians should consider medical management and conservative management in the initial treatment plan for piriformis syndrome. There are many options within the conservative management and the literature shows much promise regarding these. Physical therapy, steroid injections, botulinum toxin injections, and dry needling are all potentially effective therapies with few adverse effects.”
An October 2024 study (3) aimed to explore the immediate effect of hip exercises-inducing motor unit recruitment on postural balance in piriformis muscle syndrome patients.
- twelve patients with piriformis muscle syndrome participated in a single session of hip exercises-inducing motor unit recruitment, consisting of two exercises, bilateral bridging to target hip extensors and side lying clams to target hip abductors and external rotators.
The researchers found: “A single session of hip exercises-inducing motor unit recruitment immediately improved static postural balance (unipedal posture with eyes closed) in patients with piriformis muscle syndrome. Given that this protocol is simple and easy to implement, it is recommended that patients with piriformis muscle syndrome consider incorporating these exercises into their daily physical activity.”
An August 2021 paper (4) examined outcomes in patients treated with Platelet-Rich Plasma (PRP) for piriformis syndrome. Six hundred patients were divided into PRP and control groups. One session of PRP and one session of saline.
- The researchers found: “Ultrasound-guided PRP injection provided greater improvements in both pain and functional status in patients with piriformis syndrome, starting in the early period after treatment. A repeat injection might be needed for a long-term effect.”
A November 2024 case study (5) showed radial extracorporeal shockwave therapy piriformis syndrome improved the clinical symptoms, piriformis hardness, and cross-sectional area of the sciatic nerve in a single patient.
Dry Needling
An August 2023 paper (6) examined dry needling therapy and exercise programs on pain, neuropathic pain, physical function, and disability in patients with Piriformis syndrome.
- Forty-four Piriformis syndrome patients were divided into two groups, a group treated with (5) ultrasound guidance dry needling three times, once per week and those who had an exercise program for three weeks.
Conclusion: Both treatment showed beneficial results in reducing pain and disability, and increasing the functional status of the patients with Piriformis muscle syndrome. at three months of follow-up. . .Dry needling treatment under ultrasound guidance should be kept in mind as a minimally invasive treatment modality.
Hydro-dissection
Hydro-dissesction is the injection of fluid to separate soft tissue. A February 2022 study found: (7) “Hydro-dissection by ultrasound-guided injection of a very low concentration of local anesthetic is effective and has a lower risk of adverse effects, thus making it more convenient for the treatment of piriformis syndrome than conventional treatments, such as local anesthetics, steroids, and botulinum toxin injection.”
References
1 Hicks BL, Lam JC, Varacallo M. Piriformis Syndrome. InStatPearls [Internet] 2023 Aug 4. StatPearls Publishing.
2 Vij N, Kiernan H, Bisht R, Singleton I, Cornett EM, Kaye AD, Imani F, Varrassi G, Pourbahri M, Viswanath O, Urits I. Surgical and Non-surgical Treatment Options for Piriformis Syndrome: A Literature Review. Anesthesiology and Pain Medicine. 2021 Feb 28;11(1).
3 Öztürk GT, Erden E, Erden E, Ulašlı AM. Effects of ultrasound-guided platelet rich plasma injection in patients with piriformis syndrome. Journal of Back and Musculoskeletal Rehabilitation. 2021(Preprint):1-7.
4 Nakanishi S, Tsutsumi M, Kawanishi K, Wada M, Kudo S. Effects of Radial Extracorporeal Shockwave Therapy on Piriformis Syndrome: A Single-Case Experimental Design. Cureus. 2024 Jun 7;16(6).
5 Guner D, Ozcete ZA. Evaluation of the efficacy of ultrasound-guided dry needling therapy and exercise in piriformis muscle syndrome. Cureus. 2023 Aug 20;15(8).
6 Chaari, F., Jardak, M., Bouchaala, F., Harrabi, M.A., Rebai, H. and Sahli, S., 2024. Immediate effect of hip exercises-inducing motor unit recruitment on static and dynamic postural balance in patients with piriformis muscle syndrome. Journal of Bodywork and Movement Therapy
7 Kaga M, Ueda T. Effectiveness of hydro-dissection of the piriformis muscle plus low-dose local anesthetic injection for piriformis syndrome: A report of 2 cases. The American Journal of Case Reports. 2022;23:e935346-1.
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